About the service:

Sagecare (Southwark) Limited is a domiciliary care agency registered to provide personal care to people living in their own homes. The Care Quality Commission only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. At the time of our inspection approximately 377 people were using the service. Of those 377 people, 350 received personal care and the remainder received domestic assistance only.

People’s experience of using the service:

People reported they felt safe with staff and had developed positive relationships where they received a consistent service from regularly assigned staff. However, some people had experienced disruptions with the delivery of their care and support due to unforeseen changes to staff they were not advised about in advance, late visits, missed visits and visits that felt rushed if care workers were late.

Recruitment practices were safely conducted to ensure new staff had suitable backgrounds and experience to support people who used the service. However, the provider had not ensured that all staff were up to date with their training and received support through regular formal supervision and team meetings.

The provider had not ensured that all people who used the service had suitable care plans, so that their needs and wishes were properly identified and addressed. Some people did not have appropriate risk management guidance in place to reduce risks and promote their safety, health and wellbeing. Although staff had received medicines training, the provider did not have sufficiently robust processes in place to observe and audit how people were supported with their prescribed medicines.

People received care and support to meet their health care needs, and their nutritional needs where required. Although people's mental capacity was assessed and they were supported to make day to day choices about their personal care where possible, the provider's system for recording whether people had appointed attorneys to act on their behalf was not sufficiently detailed.

Most people stated they were happy with the caring attitudes of their regular care staff and they felt that staff promoted their entitlement to dignity, respect and confidentiality. There were mixed views from people in relation to how the provider dealt with complaints. We noted that since the appointment of the new manager there was a focused approach to addressing complaints and the underlying reasons why people expressed their dissatisfaction.

Staff did not feel they had been supported well by the management but felt that the new manager was progressing with improvements in relation to how information was communicated, staff training and support, and the systems used by office staff to plan the visits schedules.

People and relatives had experienced difficulties with the quality of the service and the professional performance of the management team. Some people expressed optimistic views that their care had recently improved. The provider had analysed in a detailed manner where the service was not functioning well and had developed an action plan. Progress was being achieved with the action plan at the time of the inspection. However the provider's own quality monitoring systems had not been properly used, which had resulted in people receiving a service with significant shortfalls.

Rating at last inspection:

This is the first inspection of the service since it was registered by the Care Quality Commission on 16 March 2018.

Why we inspected:

This was a scheduled inspection of the service.

Enforcement:

We found five breaches of regulation. These were in relation to the management of risks to people's safety, the safe management of prescribed medicines, training, supervision and support to enable staff to effectively carry out their duties, detailed care planning to identify and meet people's needs and wishes, and the implementa